Thirty-eight patients with chronic respiratory failure, including 28 patients receiving HOT, were studied from the psychosomatic viewpoint. Assessment of psychological state was based on the following 5 psychometrical tests; Cornell Medical Index (CMI), Self Rating Questionanire for Depression (SRQ-D), State Trait Anxiety Inventory (STAI), Minesota Multiphasic Personality Inventory Alexithymia Scale (MMPI-Alexithmia scale) and egogram Check List (ECL). Tweleve HOT patients were also interviewed individually over a three-year period.
The ECL showed overadaptation of non-HOT female patients, as compared with their HOT counterparts. There was an inverse correlation between PaO₂ (room air) and the SRQ-D score. A significant correlation was also found between age and the SRQ-D score in both HOT and non-HOT patients.
HOT patients were observed for 3 years (1-4 years after HOT introduction). Depressive state was observed in 16.6-36.4% of the patients throughout this observation period. Alexithymia was noted in 25.0% only 1 year after the initiation of HOT. However, the average scores for SRQ-D, STA-I and the MMPI-Alexithymia scale remained unchanged for 3 years. PaCO₂ (room air, O₂, inhalation) was significantly related to the STAI-1 score up to 2 years after starting HOT.
Furthermore, a significant correlation was seen between HOT duration and MMPI-Alexithymia scales in HOT patients. Blood gas analysis parameters (ΔPaO₂, PaCO₂ and pH) correlated significantly with respiratory scores on CMI somatic profiles.
These results suggest that blood gas status (PaO₂, PaCO₂) may have an effect on the psychological states of patients early in the course of HOT. However, social factors, such as familial or economical problems, seem to have a greater influence in later stages. Thus, more attention must be given to psychosomatic treatment in the care of HOT patients.

View full abstract

Using 50 mongrel dogs with alveolar flooding produced by oleic acid administration, the possible roles of vasoactive cyclooxygenase products on intrapulmonary shunt flow (Q_S/Q_T) and extravascular lung water (ETVI) inacutely injured lungs were assessed. suppressing cyclooxygenase activity with indomethacin administration diminished the concentrations of thromboxane (TX) B₂ and 6-keto-prostaglandin F_1α (6-keto-PGF_1α) in arterial blood, resulting in a significant reduction in Q_S/Q_T. Furthermore, indomethacin completely suppressed the increase in ETVI. Inhibition of TXA₂ generation by KY-046 (thromboxane A₂ synthase blocker) diminished the concentration of TXB₂ while increasing that of 6-keto-PGF_1α in blood. Administration of either OKY-046 or synthetic prostacyclin (PGI₂) markedly enhanced Q_SQ_T, in association with an increase in ETVI. In conclusion, the potent vasodilator prostacyclin was considered to enhance shunt flow, leading to the augmentation of edema formation.

View full abstract

Computed tomography (CT) findings were assessed in 7 patients with malignant mesothelioma. CT findings were also reviewed in 9 patients with lung cancer and pleuritis carcinomatosa and in 11 patients with tuberculous pleuritis.
Five patients with malignant mesothelioma underwent CT scans twice, on admission and from 1 to 7 months after admission. Tuberculous pleuritis could be distinguished from pleuritis carcinomatosa and malignant mesothelioma by the presence or absence of pleural nodularity and chest wall invasion. Although it was difficult to identify specific CT features clearly distinguishing malignant mesothelioma from pleurits carcinomatosa, characteristic findings of malignant mesothelioma appeared to include the rapid development and progression of pleural rind and a tendency to spread directly into the chest wall.
We divided the pleura into the four regions; upper anterior, upper posterior, lower anterior and lower posterior regions. Pleural changes were more frequently seen in the lower pleural regions than in the upper pleural regions, in malignant mesothelioma.

View full abstract

Candidates for pulmonary transplantation have been limited because of extreme susceptibility to lung infections and pulmonary edema in the brain-dead donor.
To ameliorate the donor shortage, two possibilities for expanding the donor source have been presented. i. e. xenotransplantation and transplantation from cardiac-dead donors. The present study was conducted to evaluate the possibility of lung transplantation from a non-heart-beating donor following brain death, using a canine model.
Six mongrel dogs were put into a state of brain death by elevating intracranial pressure with a balloon catheter. Following the intravenous administration of methylprednisolone and heparin used for 6-hour manage-ment following brain death mechanical ventilation was discontinued leading to cardiac arrest with in a few minutes. Excision of the left lung was scheduled for twenty minutes after cardiac arrest, followed by washing out the pulmonary vasculature with cold Ep4 solution, and orthotopic transplantation into the recipient animal.
Immunosuppresion was achieved with methylprednisolone and azathioprine.
A right pulmonary arterial occlusion test (RPAO) was performed to assess graft function immediately and 7 days postoperatively. All but one animal survived and three animals had an uneventful postoperative course, with the transplants alone according to immediate and 7 day postoperative, respectively, RPAO results.
These outcomes indicate the possible feasability of lung transplantation from non-heart-beating donors following brain death.

View full abstract

We successfully treated two male patients with nontuberculous multiloculated empyemas by early mini-thoracotomy 3 and 6 weeks, respectively, after the onset of the disease. Transcatheter urokinase instillation facilitated drainage of a hemorrhagic loculated pleural collection in one patient after the operation.
We believe that these treatments are less invasive and more effective than standard methods in providing early and complete resolution fibrinopurulent empyema in patients in whom this disorder might become chronic.

View full abstract

An 82-year-old man was admitted for evaluation of dry cough and low grade fever. A chest roentogenogram obtained on admission revealed an abnormal mass shadow at the left hilus. Trans-bronchial lung biopsy was used to make a diagnosis of small cell lung cancer. This tumor regressed spontaneously.

View full abstract

A 50-year-old woman was admitted to our hospital on April 4, 1992, because of progressive worsening of dry cough and exertional dyspnea. Moderate hypoxemia and obstructive ventilatory impairment were present. Her chest roentgenogram and CT films showed thickened bronchovascular bundles in the absence of significant parenchymal fibrosis. Transbronchial lung biopsy revealed the formation of noncaseous epithelioid cell granulomas.
Pulmonary perfusion scintigraphy showed multiple perfusion defects predominantly in the upper lung fields. Pulmonary ventilation scintigraphy showed a normal pattern. After administration of prednisolone for 3 months, her chest roentgenogram and CT films demonstrated marked decrease of infiltrates, but there was no improvement of hypoxemia and perfusion defects on pulmonary perfusion scintigraphy. Pulmonary angiography revealed multiple stenoses and occlusions of segmental and sebsegmental branches of pulmonary arteries.
Long-term steroid treatment will be necesary for this rare form of pulmonary sarcoidosis to prevent the development of pulmonary hypertension.

View full abstract

We report a case of pleuro-pulmonary cryptococcosis. An 86-year-old man was admitted to the hospital with dyspnea, a high fever and an oppressive sensation in the chest. Chest X-ray on admission revealed massive pleural effusions, interstitial shadows and consolidation with air bronchograms in both lung fields. The cause of pleural effusion was unknown.
The patient died one month later. Autopsy revealed severe pleural cryptococcosis and organizing pneumonia with a small number of cryptococci but without granuloma. To our knowledge, there have been very few documented cases of pleuro-pulmonary cryptococcosis with such massive bilateral pleural effusions.

View full abstract

A case of primary pulmonary cryptococcosis with increased serum carcinoembryonic antigen (CEA) (7.0ng/ml) is presented. The diagnosis was made by transbronchial lung biopsy (TBLB) and no abnormality was found in either gastrointestinal tract or immunity. Immunohistochemical study of the lung specimen showed that CEA was present on the surfaces of alveoli. The level of CEA fell to 0.8ng/ml after administration of an antimyocotic agent (Fluconazole) with simultaneous improvement of the chest radiographic findings. This case indicates that increased serum CEA depends on pulmonary cryptococcosis. TBLB and administration of antimycotic agents, instead of surgical resection, are useful in the diagnosis and treatment of this disease.

View full abstract

A 41-year-old male developed acute interstitial pneumonia after inhalation of Blasticidin S, an antibiotic effective against rice blast disease. He presented with diarrhea, followed by dry cough, dyspnea and fever. A chest roentgenogram showed bilateral diffuse ground glass appearance, superimposed by patchy shadows. Arterial blood gas analysis revealed severe hypoxemia. Bronchoalveolar lavage fluid specimen showed moderate increase in total cell count, lymphocytes, neutrophils and eosinophils with marked elevation of CD4/8 ratio. Antibiotic therapy with minocycline failed to improve his condition, and methylprednisolone pulse therapy followed by methylprednisolone (48mg) resulted in clinical remission with resolution of the chest roentgenogram findings. Blasticidin S should be kept in mind as a causative agent of acute interstitial pneumonia.

View full abstract

The patient was a 75-year-old male, who simultaneously showed symptoms of bacterial meningitis during steroid treatment for erythroderma and symptoms of respiratory failure. Based on ground-glass shadows in both lungs on chest X ray, bronchoalveolar lavage (BAL) was carried out and strongyloides was detected. In addition to strongyloidiasis, the patient was shown to have the complication of pneumocystis carinii (PC) pneumonia after PC DNA was detected in BAL fluid using a PCR assay. When other causes for immunodeficiency affecting the incidence of opportunistic infection were investigated, the ATL virus was detected in peripheral blood cells and monoclonal amplification was indicated, though the presence of anti-ATL antibody was negative. According to the results, this patient was found to have early stage adult T cell leukemia. In conclusion, we treated this adult T cell leukemia patient who had strongyloidiasis and amplification of PC DNA in BAL and for which the PCR assay, a new technology used for diagnosing PC pneumonia, was considered to be effective.

View full abstract

A 44-year-old man, who had suffered repeated episodes of pneumonia since 1984, was admitted with complaints of cough, low grade fever and sputum. Chest X-ray showed a mass shadow in the left lower lobe. Bronchofiberscopy revealed a tumor with a smooth surface which obstructed the B9 bronchus. Left lower lobectomy was performed despite the lack of evidence of malignancy because of the recurrent pneumonia. The resected specimen contained a smooth-surfaced tumor, 18mm in size, protruding into a bronchial lumen. The pathological diagnosis was leiomyoma of the lower bronchus and the specimen showed organized pneumonia with necrosis in the left S8-S10 region.
Primary benign tumors of the lung are rare and leiomyoma of the lung is particularly rare. Only 65 cases have been reported in the Japanese literature. We report here a case of leiomyoma of the lower bronchus.

View full abstract

We report a case of bronchiectasis with marked thickening of the respiratory tract wall occurring in a 37-year-old man with UC and HAM. He was diagnosed as UC at age 20. HTLV-1 was presumably transmitted to this patient by means of a blood transfusion he received at around age 30. On admission, chest X-ray films, tomography and CT-scan revealed dilated lumens and thickened airway walls extending from the trachea to subsegmental bronchi. Pulmonary function tests showed hypoxemia and mixed ventilatory disturbance with a predominantly obstructive component. HAM was diagnosed on the basis of neurological examination and cerebrospinal fluid analysis. A biopsy specimen from the carinal mucosa showed marked T cell infiltration. In these T cells, we detected polyclonal integration of HTLV-1 proviral DNA. Some of the infiltrating T cells showed atypia. In recent times, respiratory diseases other than infiltration of adult T-cell leukemia cells or opportunistic infection have been reported in HTLV-1 carriers and new clinical entities designated as HABA (HTLV-1 associated bronchiolo-alveolar disorder) and HBA (HTLV-1 associated bronchopneumonopathy) have been proposed. This case is classified among these new entities, in a broad sense, and is a rare case in that the respiratory disorder is apparently related to UC.

View full abstract

A 66-year-old woman, who had complained of left ptosis and been diagnosed as having myasthenia gravis (ocular type) 9 years previously, was admitted to our hospital for further examination of an abnormal mass shadow on chest X-ray film. Chest computerized tomography (CT) revealed a cystic tumor in the anterior mediastinum and thoracotomy was performed to make a definitive diagnosis. The tumor could be removed completely and was diagnosed histologically as a thymic cyst with thymoma. The cyst was 32×30×28mm in size and contained about 10ml of brown turbid fluid. The levels of CEA (61.3ng/ml), SLX (24000U/ml) and CA125 (1300U/ml) were markedly increased in the cystic fluid, while those in serum were not elevated. Immunohistochemical staining demonstrated the epithelial cells lining the cyst to contain SLX. The findings suggest that SLX was produced in the epithelial cells of the cyst. Howerver, neither CEA nor CA125 was positive in the epithelial cells. From our review of reported cases of thymic cyst showing elevated levels of tumor markers in the cystic fluid, the main mechanism of marked elevation of tumor markers seems to be condensation in the cystic fluid rather than increased production in epithelial cells lining the cyst. Cases of thymic cyst with thymoma are extremely rare, but our case was concluded to be incidentally associated with non-invasive thymoma.

View full abstract

A 72-year-old woman was admitted to the hospital because of hypoglycemia. Her glucose level on admission was 40mg/dl. A giant intrathoracic mass was demonstrated on X-ray, Computerized tomographic scan of the cerebrum showed no abnormalities. Serum insulin and C-peptide levels were within normal limits.
The mass (weight 2.3kg) and the right lower lobe were excised by thoracotomy and the hypoglycemia ceased.
Pathological examination revealed the mass to be a localized fibrous tumor of the pleura.

View full abstract

A 44-year-old female was admitted to our hospital for the purpose of undergoing hysterectomy for removal of multiple uterine tumors. A chest X-ray film obtained on admission revealed a solitary nodule in the right lung field. The resected specimen containing the uterine tumors revealed well differentiated leiomyoma with no nuclear atypia or mitotic figures. The resected specimen from the pulmonary tumor revealed histologic findings similar to those of the uterine myomas, being devoid of any signs of mitosis.
Similar cases have been reported as so-called benign metastasizing leiomyoma, and are generally regarded as low grade malignancy or leiomyomatosis. However, we consider this case to have had a primary pulmonary leiomyoma associated with uterine myoma since the pulmonary lesion was solitary and no mitotic figures were detectable. As the concept of metastasizing leiomyoma is confusing, the accumulation of additional case reports is necessary.

View full abstract

A forty-year-old woman was admitted to our hospital because of a severe attack of bronchial asthma. The asthmatic attack developed 3 hours after her rubbing a large amount of a lotion containing a non-steroidal antiinflammatory drug (NSAID), ketoprofen, over her skin. The patient had a past history of asthmatic attack induced by another NSAID (Sedes-G^®) given per os. The previous asthmatic attack developed about 20 minutes after she was given the NSAID per os, but the presently reported attack developed about 3 hours after her rubbing the lotion containing the NSAID over her skin. The relatively long interval between the per cutaneous NSAID administration and the onset of the asthmatic attack indicates that the time delay is dependent on the absorption route of the adminisered NSAID. The severity of the attack is considered to be related to the amount of NSAID absorbed.

View full abstract